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Please note that the OMB number and expiration date may not have been determined when this Information Collection Request and associated Information Collection forms were submitted to OMB. The approved OMB number and expiration date may be found by clicking on the Notice of Action link below.
View ICR - OIRA Conclusion
OMB Control No:
0938-1085
ICR Reference No:
201005-0938-001
Status:
Historical Active
Previous ICR Reference No:
201004-0938-007
Agency/Subagency:
HHS/CMS
Agency Tracking No:
Title:
Temporary High Risk Pool Program (CMS-10319)
Type of Information Collection:
Revision of a currently approved collection
Common Form ICR:
No
Type of Review Request:
Emergency
Approval Requested By:
05/06/2010
OIRA Conclusion Action:
Approved with change
Conclusion Date:
05/25/2010
Retrieve Notice of Action (NOA)
Date Received in OIRA:
05/05/2010
Terms of Clearance:
This approval covers the application only. CMS will submit a separate request for approval of reporting and other burdens associated with the high risk pool program.
Inventory as of this Action
Requested
Previously Approved
Expiration Date
10/31/2010
6 Months From Approved
10/31/2010
Responses
153
0
102
Time Burden (Hours)
34,884
0
204
Cost Burden (Dollars)
0
0
0
Abstract:
The revised data collection will include requirements outlined in both the regulation and the application to submit the following: o The application for a state or its designated entity to request participation in the temporary high risk pool program; o Contract acceptance for those states or its designated entity who submit an acceptable application to HHS; o Payment invoices; o Reporting requirements; o Dumping reporting requirements; and o Audit requirements. This above information will assist HHS in planning for and executing contracts with States to provide a high risk pool program.
Emergency Justfication:
In accordance with Section 1101 of The Patient Protection and Affordability Care Act, H.R. 3590 the U.S. Department of Health and Human Services (HHS) is tasked with establishing a "temporary high risk health insurance pool program" to provide health insurance coverage to currently uninsured individuals with pre-existing conditions. This temporary high risk health insurance pool program has a statutory implementation date of July 1, 2010. Due to the urgency and the short time frames associated with this requirement, HHS does not have sufficient time to follow the normal notice and comment periods associated with the normal OMB approval process. Therefore, we are requesting an emergency review and approval for this information collection request.
Authorizing Statute(s):
PL:
Pub.L. 111 - 148 1101
Name of Law: Patient Protection and Affordable Care Act
Citations for New Statutory Requirements:
PL: Pub.L. 111 - 148 1101 Name of Law: Patient Protection and Affordable Care Act
Associated Rulemaking Information
RIN:
Stage of Rulemaking:
Federal Register Citation:
Date:
Not associated with rulemaking
Federal Register Notices & Comments
Did the Agency receive public comments on this ICR?
No
Number of Information Collection (IC) in this ICR:
3
IC Title
Form No.
Form Name
Application
CMS-10319
CMS - 10319 - Full Solicitation for State Proposals
Letter of Intent
CMS-10319
Appendix A
Submission of Contact Information
CMS-10319
Appendix A
ICR Summary of Burden
Total Approved
Previously Approved
Change Due to New Statute
Change Due to Agency Discretion
Change Due to Adjustment in Estimate
Change Due to Potential Violation of the PRA
Annual Number of Responses
153
102
51
0
0
0
Annual Time Burden (Hours)
34,884
204
34,884
0
-204
0
Annual Cost Burden (Dollars)
0
0
0
0
0
0
Burden increases because of Program Change due to Agency Discretion:
No
Burden Increase Due to:
Burden decreases because of Program Change due to Agency Discretion:
No
Burden Reduction Due to:
Short Statement:
We are revising the information collection request to include the application for the Temporary High Risk Pool Program. The burden associated with both the Letter of Intent and the Submission of Contact Information has been removed as those requirements imposed one-time burdens.
Annual Cost to Federal Government:
$48,000
Does this IC contain surveys, censuses, or employ statistical methods?
No
Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002?
No
Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]?
Yes
Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]?
Uncollected
Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)?
No
Is this ICR related to the Pandemic Response?
Uncollected
Agency Contact:
William Parham 4107864669
Common Form ICR:
No
On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
(a) It is necessary for the proper performance of agency functions;
(b) It avoids unnecessary duplication;
(c) It reduces burden on small entities;
(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;
(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;
(f) It indicates the retention periods for recordkeeping requirements;
(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:
(i) Why the information is being collected;
(ii) Use of information;
(iii) Burden estimate;
(iv) Nature of response (voluntary, required for a benefit, or mandatory);
(v) Nature and extent of confidentiality; and
(vi) Need to display currently valid OMB control number;
(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.
(i) It uses effective and efficient statistical survey methodology (if applicable); and
(j) It makes appropriate use of information technology.
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
Certification Date:
05/05/2010
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